Discussion: Critical Thinking

Recall your early clinical nursing experiences—what guided your decisions? Did you practice nursing ‘by the book’? Now, consider how you make decisions today. How have your clinical experiences fostered a greater depth of knowledge and critical thinking?

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This week’s Learning Resources explore skill development and levels of knowledge acquisition based on clinical experience. For example, Benner suggests that as a nurse gains more experience, knowledge and skill level increases. Nurses move from novices—making decisions based on rules—to experts who are able to see connections between actions and outcomes using critical thinking. This Discussion focuses on the role of critical thinking in nursing practice and the connection between critical thinking, clinical competence, and scholarship.

To prepare:

• Review the Learning Resources focusing on critical thinking and Benner’s interpretation of the Novice to Expert theory.
• Reflect on how critical thinking is used in clinical practice. How does critical thinking relate to, or support, clinical competence?
• What critical thinking strategies do you use to improve your clinical competence and thus move from novice to expert?
• Consider the connection between critical thinking, nursing practice, and scholarship.

BY DAY 3

Post your observations on how critical thinking is used in clinical practice (provide examples); how you employ critical thinking strategies to improve clinical competence; and your thoughts on the connections between critical thinking, scholarship, and practice.

Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course.

COURSE MATERIAL

Benner’s stages of clinical competence – NSW Health, NaMO – WOW Project tool 2011 Page 1 Benner’s Stages of Clinical Competence In the acquisition and development of a skill, a nurse passes through five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. Stage 1: Novice The Novice or beginner has no experience in the situations in which they are expected to perform. The Novice lacks confidence to demonstrate safe practice and requires continual verbal and physical cues. Practice is within a prolonged time period and he/she is unable to use discretionary judgement. Stage 2: Advanced Beginner Advanced Beginners demonstrate marginally acceptable performance because the nurse has had prior experience in actual situations. He/she is efficient and skilful in parts of the practice area, requiring occasional supportive cues. May/may not be within a delayed time period. Knowledge is developing. Stage 3: Competent Competence is demonstrated by the nurse who has been on the job in the same or similar situations for two or three years. The nurse is able to demonstrate efficiency, is coordinated and has confidence in his/her actions. For the Competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic contemplation of the problem. The conscious, deliberate planning that is characteristic of this skill level helps achieve efficiency and organisation. Care is completed within a suitable time frame without supporting cues. Stage 4: Proficient The Proficient nurse perceives situations as wholes rather than in terms of chopped up parts or aspects. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long-term goals. The Proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The Proficient nurse can now recognise when the expected normal picture does not materialise. This holistic understanding improves the Proficient nurse’s decision making; it becomes less laboured because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones. Stage 5: The Expert The Expert nurse has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions. The Expert operates from a deep understanding of the total situation. His/her performance becomes fluid and flexible and highly proficient. Highly skilled analytic ability is necessary for those situations with which the nurse has had no previous experience. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.